Lupine Publishers | Journal of Oral Healthcare
Abstract
Often in the profession of dentistry, a new or novel instrument, material,
technique, and/or “system” is introduced which can incur a “state-of-the-art”
status without necessarily being subjected to the rigors of clinical testing or
longitudinal patient-based studies prior to receiving the stamp of approval or
the moniker of “standard of care”. Recently, provocative terminology
surrounding the field of dental materials has been publicized through the
literature, promoting exciting claims and possible long-term advancements for
patient care. In this “new era” of evidence-based restorative dentistry;
conservative interdiction, i.e. “informed” removal of diseased tissue with
concurrent substitution considering form and function, esthetics, and the
interaction of the physical and mechanical properties of the replacement
materials with living, dynamic structures found in the human tooth, has been of
paramount importance.
Abbrevations: ACP: Amorphous Calcium Phosphates, MTA: Mineral
Trioxide Aggregate, PVPA: Poly Vinyl Phosponic Acid, PAA: Polyacrylic Acids
Introduction
The progression or evolution of dentistry has occurred, to a great degree,
in concert, with the development of material technology [1]. During the last
two decades, the categorization of dental materials, specifically, adhesive
systems and composite resins have included the term “nanotechnology” into the
lexicon of scientific literature [2]. Nanotechnology involves the science and
engineering of functional molecules at the nanoscale (onebillionth of a meter)
level [2]. As applied to dentistry, this innovative approach promotes the
incorporation or interaction of nanostructured materials together with the
complex arrangement of organic/inorganic molecular-level constituents
comprising living tooth structure, allowing for a myriad of possible preventive
and therapeutic applications [2]. Owing to this progression of material
development, the assignments of additional revolutionary dimensions have
included the origination of the concepts of biocompatibility or bioactivity into
dental science.
As a possible expansion of nanotechnology applied to dental materials: the
terms biocompatible, bioactive, bioinduction, and biomimetics can be defined
independently; however, have often been characterized synonymously [3].
Biocompatible is simply a term to describe a substance or material that will do
no harm to existing living structures, that is non-mutagenic and noncytotoxic.
The term “bioactivity” was first described in 1969 by Hench, whereby a
“bioactive material is one that elicits a specific biological response at the
interface of the material which results in the formation of a bond between the
tissues and the material” [4]. Furthermore, the definition was refined and
updated to include two categories based upon intent and procedure, originally
pertaining, specifically, to bone tissue:
a) Class A: A material that elicits an intracellular and extracellular
response (osteoproductive);
b) Class B: Materials eliciting an extracellular response only
(osteocontuctive) [5].
Accordingly, a bioactive material can have “the effect on, or eliciting a
response from living tissue, organisms, or cells”, thus contributing to the
formation of a new substance or creation of a living, compatible system [3]. A
bioinductive property is defined as “the capability of a material for inducing
a response in a biologic system”[3]. Biomimetics is the “study of formation,
structure, or function of biologically produced substances and materials and
biological mechanisms and processes for the purpose of synthesizing similar
products by artificial mechanisms that mimic natural substances”[3,6]. So,
although these terms seem to imply different connotations, what can a dental
practitioner conclude, deduce, and/or apply for everyday use? Any substance,
arrived from by any process (bioactive, bioinduction, biomimetic) should
exhibit attributes of being biocompatible. It appears that both a bioactive and
biomimetic substance can include the process of bioinduction and that a
biomimetic substance could possibly be produced through bioactive activities.
Bioactive materials and processes are probably the most applicable for
endodontics and restorative dentistry based upon current uses: luting cements,
pulp capping agents, root repair materials, permanent restorations, hard tissue
remineralization (fluoride, calcium, and phosphate ions) and bone regeneration
properties, and treatment of dentinal hypersensitivity[1,3,7-13]. In order for
these materials to become biocompatibily active or retain characteristics of
bioactivity; bactericidal and bacteriostatic (inhibits bacterial growth and
biofilm formation) properties for the stimulation of reparative dentin
formation and maintenance of pulpal vitality must be achieved and maintained
[3]. Examples include fluorides for remineralization, antibacterial resins and
cements (Reactimer bond™ Shofu Dental Corp., Kyoto, Japan; ABF™ Kuraray,
Kurasiki, Japan), restoratives (Active™ BioACTIVE, PULPDENT Corp., Watertown,
MA, USA) releasing fluorides and containing amorphous calcium phosphates [ACP],
medicaments (mineral trioxide aggregate [MTA] and bioaggregate; Biodentine™,
Septodont, Lancaster, PA, USA; TheraCal™, Bisco Dental Products, Schaumburg,
ILL, USA; and Endosequence root repair [RRM]™, Brasseler USA, Savannah, GA),
and luting cements (Ceramir Crown & Bridge, Doxa Dental Inc., Chicago, ILL,
USA) that induce healing and/or for creation of new tooth
structures[1,3,7,8,10-14]. Biomimetic substances include the usage of
polyvinylphosponic acid (PVPA) polyacrylic acids (PAA) as calcium phosphate
matrix protein analogues for remineralization purposes [7,15].
Conclusion
Although these materials are in their infancy, with long-term efficacy based
on improvements of mechanical and physical properties pending, future materials
will hopefully create circumstances for increased tooth-like attributes due to
properties of adhesion, remineralization, and integration [1,3,7].
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